Prevention the only cure for dengue
Dr Jagdish Chander

Mosquito Aedes Aegypti

Most of the north Indian states are in the grip of dengue fever. The cases are mainly being reported from Delhi, Haryana, Uttar Pradesh, Punjab and Chandigarh. Many doctors and medical students at AIIMS, New Delhi, are among the sufferers.

The disease is characterised by sudden high fever, frontal headache and pain in the bones, joints and muscles. Because of the pain in the bones it is also called “breakbone fever”.

Dengue virus

Dengue fever as a clinical entity has been known for about two centuries. But for the first time its causative virus was identified by Dr Albert Sabin in 1944. He also developed the oral polio vaccine.

The dengue virus is transmitted by an infected female mosquito, Aedes Aegypti, after the completion of extrinsic incubation period of 8 to 10 days. Once infected with the virus, mosquito remains infected for its life and its life span is about four to six weeks. Aedes has white and black stripes on the body with banded legs and hence known as tiger mosquito. This mosquito breeds in and around the houses in the urban and semi-urban areas. The Aedes mosquito bites during the day, especially at dawn and dusk. This is the time when the effect of the most repellents has worn off. On the contrary, mosquito transmitting malaria — Anopheles — bites during night- time.

It is basically a container breeder mosquito and, therefore, found over flower vases, tins, tyres, roof gutters, broken glass bottles, pitchers, tin covers, desert coolers, tree cavities, etc. The eggs laid by the mosquito may be able to survive even for a period of three years. It can fly up to 100-110 yards and hence is generally confined to the domestic indoor atmosphere.

The disease manifests in the following two forms:

1. Classical dengue fever: The classical dengue fever (DF) is the predominant type, often seen in older children and adults. It has a relatively benign flu-like course with an intrinsic incubation period ranging from five to eight days followed by the sudden onset of fever, violent headache and severe pain in the muscles, joints and bones. The rash may appear on the third or fourth day of the disease. The febrile illness lasts about a week.

2. Dengue haemorrhagic fever: It is the severe form of the disease and remains mostly confined to infants and young children of six to eight years in an area where multiple dengue virus serotypes cause the disease. Haemorrhagic dengue appears to be a hyper-immune response. It is invariably seen in the patients previously infected with the dengue virus. On re-infection with a different strain of virus within a period of two years of infection, antibodies formed against the first virus strain react with the second sub-type forming immune complexes.

The initial symptoms are like classical dengue fever but associated with haemorrhagic rash, thrombocytopenia and shock. Bleeding time and prothrombin time are prolonged due to the fall in the platelets’ count. There may be haemorrhages in the skin and ears and the nose. The patients with hematemesis, melena and coma have poor prognosis. The dengue shock syndrome (DSS) is still a more fatal disease where patients have hypovolumic shock leading to circulatory collapse.

Prevention and treatment

The control of dengue fever includes anti-mosquito and anti-larval measures.

The vector mainly breeds over the stagnate artifical water collection sites in the household atmosphere and hence preventive. Control measures are to be taken keeping the following points in view:

(a). Water should be removed from air-coolers, small containers and flower vases in and around the houses where the Aedes mosquito breeds.

(b). Water tanks should be kept covered so that the entry of mosquitoes may be prevented, avoiding contact with stored water.

(c). Insecticides like pyrethrum should be sprayed in the houses to kill the adult mosquitoes.

(d). Mosquito repellents in the form of creams containing DEET (diethyl-toluamide) should be used along with the mosquito nets.

(e). Wearing of long-sleeved shirts and pants should be practised to avoid mosquito bites.

As such, there is no specific treatment for dengue fever. It is mainly the symptomatic one, based on the clinical manifestations in the patient. In the case of simple fever, paracetamol is sufficient round the clock. However, aspirin and disprin should be avoided as these may increase bleeding tendencies.

The writer is Professor and Head, Department of Microbiology, Government Medical College and Hospital, Sector 32, Chandigarh.

Hip pain: treat the cause
Dr Ravinder Chadha

Hip pain is a more widespread affliction than is realised. It implies any pain in or around the hip joint. Hip pain can affect all age groups from infants to elderly individuals. Pain could be experienced in the buttocks, the upper lateral thigh or the groin.

Hip pain could also be a referred pain from the back and sometimes from the knee. Pain in the buttocks can be due to multifarious reasons like injury, infection, tumour, arthritis, etc.

A muscle injury or bursitis most often causes pain on movement. Pain with weight-bearing increases when a person stands or walks forcing him to limp is usually caused due to hip joint involvement.

Pain that is worse in the morning and improves during the day may be due to osteoarthritis. Pain that radiates to the leg from the hip or the low back may be due to sciatica. Hip with groin pain may be due to fracture of the neck of femur, pelvis, etc. Hip fractures become more common as people age because bones become less dense due to osteoporosis and falls are more likely. A hip fracture can change the quality of one’s life significantly.

Aseptic necrosis occurs when an individual is on steroids for a long time or suffering from sickle cell anaemia, injury or history of alcohol consumption on a regular basis. Perthes disease is a type of aseptic necrosis that occurs in children.

Hip replacement may be recommended for aseptic necrosis, hip fracture and severe arthritis. Expect recovery from surgery to take at least six weeks. A blood clot in the leg is the most common complication, which can lead to a blood clot in the lungs.

Prevention

Avoid falls. Try to avoid activities that aggravate the pain like running on an uneven surface. Sleep on the non-painful side with a pillow between legs.

Certain exercises that help relieving pain:

* Warm up before exercising and cool down afterwards. This will relieve pain. Stretch hips, low back and thighs. When pain improves, resume walking slowly and carefully.

* HIP RAISE — Support yourself on elbows and knees, with hands together in front. Keep the back straight and the right leg bent and raise it up in the air. Keep the foot flat and press up into the heel. Count 5 upward and 2 downwards. Repeat 10 times.

*STANDING HIP RAISE — Stand straight with hands on the wall. Bend one leg to 90 degrees backwards and push the sole of your foot away from you. Repeat five times.

* PELVIC RAISE — Lie flat on your back with your heels up on a bench/chair, knees bent at 90 degrees and hands at the back of the head. Raise pelvis off the floor by squeezing the buttocks until your body is straight from knees to chest. Return back. Repeat 5-10 times.

* GLUTEAL STRETCHING — Lie on the back, clasp one leg from the back of the thigh and pull it towards the body to stretch the gluteal muscles.

* Pain in the hip can occur due to osteoarthrosis, displacement, muscular lesions, stress fractures and, above all, referred pain from the lumbar spine. Therefore, diagnosing the cause of the pain is very important to provide appropriate treatment.

The writer is a former doctor/ physiotherapist, Indian cricket team.

With herbs, it is time to let your hair down

NEW DELHI: Don’t let down your hair! Let the home remedies do the hair care. Among the various entities which reflect personality, hair is a prominent one. Hence, hair related problems are a matter of concern.

In comparison to the unpredictable synthetic shampoos flooding the markets, herbs and its formulations have been known to be effective in proper upkeep and treating hair-related problems.

Indian gooseberry (amla) is an accepted hair tonic in traditional recipes for enriching hair growth and pigmentation.

Premature graying of hair has become a common phenomenon. Worries and diet lacking in Vitamin B, iron, copper and iodine are the primary causes of this problem. Other causes being washing hair with hot water, use of electric dryer and use of hair dyes. Heredity is also a predisposing factor.

A liberal intake of curry leaves (curry patta) is known to have preventive abilities in graying of hair. Curry leaves nourish the hair roots. Hereafter, new roots that grow are healthier with normal pigment. The leaves can be used in the form of chutney or the juice may be squeezed and taken in buttermilk or lassi.

Sage (salvia or sefakuss) blended in hair tonics is useful in preventing gray hair.

For treating the graying of hair disorder, a finely powdered mixture of two parts of Trailing Eclipta (Bhangra), one part of black sesame seeds and one part of Indian gooseberry (amla) can be prepared. One teaspoonful of this powder can be taken with milk and sugar twice daily. — ANI